Unusual Case of Bevacizumab-Related Osteonecrosis of the Jaw Associated with Dental Implant Surgery

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is defined as the development of bone necrosis in the jaws related to antiresorptive or antiangiogenic drugs. In this report, we present an original case of a 54-year-old female patient with a metastasizing breast cancer receiving bevacizumab and carboplatin as treatment. She was referred to the dental service because of a local infection, and after a 2-month drug holiday, dental extractions and immediate implant surgery in the mandible were performed. After 5 weeks, drainage of a purulent secretion was observed; bone exposure was detected, and the patient reported pain. Conservative treatment was initially indicated, and after 10 sessions with water and ozonized oil plus ciprofloxacin, there was no pain or drainage of the purulent secretion; however, bone sequestration with mobility of the implants was observed. Thus, surgical debridement and removal of the implants were performed, and the biopsy confirmed MRONJ stage 2. A 4-month follow-up revealed complete healing.